Provider Demographics
NPI:1093808586
Name:KUBAL, VIPUL
Entity Type:Individual
Prefix:DR
First Name:VIPUL
Middle Name:
Last Name:KUBAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 S EASTERN AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5174
Mailing Address - Country:US
Mailing Address - Phone:702-629-3146
Mailing Address - Fax:702-527-5966
Practice Address - Street 1:3950 S EASTERN AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5174
Practice Address - Country:US
Practice Address - Phone:702-629-3146
Practice Address - Fax:702-527-5966
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1311OtherSTATE LICENSE